Clinical InvestigationImaging and Diagnostic TestingDetermining myocardial viability in chronic ischemic left ventricular dysfunction: A prospective comparison of rest-redistribution thallium 201 single-photon emission computed tomography, nitroglycerin-dobutamine echocardiography, and intracoronary myocardial contrast echocardiography
Section snippets
Methods
We prospectively recruited patients referred for clinically indicated coronary angiography. Intracoronary MCE was performed after angiography for patients who had (1) LV ejection fraction (LVEF) <40% by transthoracic echocardiography (TTE), (2) significant multivessel disease (≥50% diameter stenosis), and (3) coronary anatomy suitable for revascularization.
Contraindications to participation were (1) myocardial infarction, coronary artery bypass grafting surgery, or percutaneous coronary
Results
Characteristics of the 32 patients are detailed in Table I.
Discussion
The present study evaluated a variant pharmacologic stress protocol, comprising multistage dobutamine administration at low and moderate doses,3, 13 longer-stage duration,14 and front-loading with nitroglycerin. Biphasic RWM, considered most predictive of viability,13 was observed at dobutamine doses ≤20 μg/kg per minute in 97% of responsive segments. The initial improvement (mode 5 μg/kg per minute) and subsequent worsening of contractility in RWM (most at 10-15 μg/kg per minute) were observed
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Cited by (26)
Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography
2020, Journal of the American Society of EchocardiographyCitation Excerpt :FDG and perfusion imaging techniques have greater sensitivity for identifying subjects with improvement in global function and DSE has greater specificity.272 However, other echocardiographic studies have shown both high sensitivity and specificity of contractile reserve for prediction of improvement of global function.31 Comparative safety of testing modalities should also be considered.
Controversies in Diagnostic Imaging of Patients With Suspected Stable and Acute Chest Pain Syndromes
2019, JACC: Cardiovascular ImagingCitation Excerpt :Even in those situations in which abnormal stress echocardiograms do not correspond with stenoses of major epicardial vessels by invasive coronary angiography, echocardiography results identify patients at increased risk for mortality in whom risk factor modification is indicated (77). Stress echocardiography, particularly when performed with bicycle or dobutamine stress with multistaged imaging, allows accurate recognition of viable myocardium and identifies myocardium with potential for recovery of function (78). Various methods of quantitating extent and severity of ischemia have been used.
The Clinical Use of Stress Echocardiography in Non-Ischaemic Heart Disease: Recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography
2017, Journal of the American Society of EchocardiographyCitation Excerpt :During both exercise and inotropic stress, a normal response involves the augmentation of function in all segments and increases in LVEF and cardiac output.1,2 The presence of a new or worsening wall motion abnormality identifies ischaemia while the improvement of regional wall motion by ≥1 grade in dysfunctioning segments characterizes recruitable viable myocardium.16 Global contractile reserve in patients with no regional resting dysfunction is often defined as an increase by ≥5% in LVEF while a flow reserve is defined as an increase in forward stroke volume by ≥20%.
Stress Echocardiography: Introduction
2015, ASE’s Comprehensive EchocardiographyViability by MRI or PET Would Not Have Changed the Results of the STICH Trial
2013, Progress in Cardiovascular DiseasesCitation Excerpt :Potential advantages of PET compared to SPECT include its higher spatial, temporal, and contrast resolution, and more robust built-in attenuation correction, which permit quantification of myocardial blood flow and myocardial glucose utilization not readily available with conventional SPECT imaging14 Although these measurements should add value to PET viability assessment, PET image analysis and interpretation at most institutions are still limited to the visual evaluation of relative myocardial blood flow and/or glucose metabolism in a 17-segment model, a methodological approach also used in SPECT image interpretation. There are limited data comparing outcomes of patients based on different viability imaging techniques, and these are small single center studies..15,16 One notable study found no difference in cardiac events of patients treated on the basis of PET compared to SPECT viability imaging results.16
Myocardial Viability: Comparison with Other Techniques. Comparison with Other Techniques.
2010, Clinical Nuclear Cardiology: State of the Art and Future Directions